Which Culture, Which Choice? Exploring Culture’s Influence on Medical Entrepreneurs’ Ethical Decision-Making
DOI:
https://doi.org/10.54536/jebs.v2i1.6630Keywords:
Cultural Factors, Ethical Decision-Making, Medical Entrepreneurs, Religion, Thematic AnalysisAbstract
In North Africa, particularly Tunisia, medical practice operates at the intersection of Arab-Islamic traditions, strong familial obligations, and a bureaucratic healthcare system. This configuration generates a distinctive ethical environment in which medical entrepreneurs must reconcile religious norms, social expectations, patient involvement, and administrative constraints. Such complexity necessitates an in-depth examination of the cultural variables that shape ethical decision-making. This study aims to explore ethical decision-making among medical entrepreneurs by analyzing the influence of culturally embedded factors. A qualitative design was adopted using semi-structured interviews with 21 medical entrepreneurs from diverse medical specialties. Purposive sampling ensured variation in gender, age, specialty, and professional experience. Data were analyzed through reflexive thematic analysis using NVivo 10, following an interpretivist paradigm that enabled the progressive construction of meaning based on participants’ narratives. The findings indicate that ethical decision-making is strongly anchored in the Tunisian socio-cultural context. Family background emerged as a central moral reference guiding professional behavior. Ethical practice was found to be culturally relative, challenging universalist ethical models, while religious faith functioned as a system of metaphysical accountability. Additionally, socioeconomic precarity was identified as a structural factor that can undermine professional integrity. Ethical decision-making among Tunisian medical entrepreneurs is a contextualized process shaped by the interaction of familial, religious, and socioeconomic factors alongside universal ethical principles. These results highlight the need for culturally sensitive ethical frameworks adapted to resource-constrained healthcare environments.
References
Adib, S. M. (2004). From the biomedical model to the Islamic alternative: a brief overview of medical practices in the contemporary Arab world. Social Science & Medicine. https://doi.org/10.1016/S0277-9536(03)00221-1
Azevedo, S. G., & Nunes, C. S. (2024). Business Ethics and Ethical Behavior. https://doi.org/10.1016/b978-0-443-13701-3.00143-2
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
Beekun, R. I., Westerman, J. W., & Barghouti, J. A. (2005). Utility of ethical frameworks in determining behavioral intention: A comparison of the U.S. and Russia. Journal of Business Ethics, 61, 235-247. https://doi.org/10.1007/s10551-005-4775-1
Ben Amor, F., Ben Zakour, Z., Dellagi, H., & Dakoumi Hamrouni, A. (2025). On Ethical Decision-Making in Healthcare: The Tunisian Post-Revolution Context. International Journal of Research and Innovation in Social Science. https://doi.org/10.47772/IJRISS.2025.917PSY0079
Ben Amor, F., Dakoumi Hamrouni, A., & Dellagi, H. (2025). The Trust in Doctors’ Dilemma: Investigating the Role of Patients’ Perceived Communication. International. Journal of Research and Scientific Innovation, 12(11), https://doi.org/10.51244/IJRSI.2025.12110016
Ben Amor, F., Hamrouni, A. D., & Dellagi, H. (2026). 66 YEARS OF RELIGIOUS RESEARCH IN MARKETING: WHAT DOES LITERATURE HAVE TO REVEAL?. Scientific Culture, 12. https://doi.org/10.5281/zenodo.17753387
Benatar, S. R. (2002). Reflections and recommendations on research ethics in developing countries. Social Science & Medicine, 54(7), 1131–1141. https://doi.org/10.1016/S0277-9536(01)00327-6
Beu, D. S., Buckley, M. R., & Harvey, M. (2003). Ethical decision–making: a multidimensional construct. Business Ethics: A European Review. https://doi.org/10.1111/1467-8608.00308
Birt, L., Scott, S., Cavers, D., Campbell, C., & Walter, F. (2016). Member checking: A tool to enhance trustworthiness or merely a nod to validation? Qualitative Health Research, 26(13), 1802–1811. https://doi.org/10.1177/1049732316654870
Blank, R. H. (2011). End‐of‐Life Decision Making across Cultures. Journal of Law Medicine & Ethics. https://doi.org/10.1111/J.1748-720X.2011.00589.X
Brammer, S., Williams, G. C., & Zinkin, J. (2005). Religion and Attitudes to Corporate Social Responsibility in a Large Cross-Country Sample. Social Science Research Network. https://doi.org/10.2139/SSRN.905182
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. https://doi.org/10.1080/2159676X.2019.1628806
Chattopadhyay, S., & De Vries, R. (2013). Respect for cultural diversity in bioethics is an ethical imperative. Medicine, Health Care and Philosophy, 16(4), 639–645. DOI: https://doi.org/10.1007/s11019-012-9433-5
Craft, J. L. (2013). A review of the empirical ethical decision-making literature: 2004–2011. Journal of Business Ethics, 117(2), 221–259. https://doi.org/10.1007/s10551-012-1518-9
Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). Sage Publications.
Davey, T. L. (2013). Individual and organizational ethical practices. Healthcare Management Forum. https://doi.org/10.1016/J.HCMF.2013.01.001
Devlin, B., & Magill, G. (2006). The process of ethical decision making. Best Practice & Research Clinical Anaesthesiology. https://doi.org/10.1016/J.BPA.2006.09.001
Ford, R. C., & Richardson, W. D. (1994). Ethical decision making: A review of the empirical literature. Journal of Business Ethics, 13(3), 205–221. DOI: https://doi.org/10.1007/BF02074820
Ford, R. C., & Richardson, W. D. (2013). Ethical decision making: A review of the empirical literature. In A. C. Michalos & D. C. Poff (Eds.), Citation Classics from the Journal of Business Ethics (pp. 19-44). Springer. https://doi.org/10.1007/978-94-007-4126-3_2
Fritzsche, D. J. (1995). Personal values: Potential keys to ethical decision making. Journal of Business Ethics. https://doi.org/10.1007/BF00882069
Gelbrich, K., Stedham, Y., & Gäthke, D. (2016). Cultural Discrepancy and National Corruption: Investigating the Difference between Cultural Values and Practices and Its Relationship to Corrupt Behavior. Business Ethics Quarterly. https://doi.org/10.1017/BEQ.2016.29
Georgieva, V., Andreevska, K., & Petkova, V. (2024). Models of ethical decision making in the field of healthcare services: A literature review. Acta Medica Bulgarica, 51(S2), 182–187. https://doi.org/10.2478/AMB-2024-0068
Graham, J., Meindl, P., Beall, E., Johnson, K. M., & Zhang, L. (2016). Cultural differences in moral judgment and behavior, across and within societies. Current Opinion in Psychology. https://doi.org/10.1016/J.COPSYC.2015.09.007
Grol-Prokopczyk, H. (2013). Thai and American doctors on medical ethics: Religion, regulation, and moral reasoning across borders. Social science & medicine, 76, 92-100.
Habib, T., Richa, K., & Abou-Mrad, F. (2021). Challenges of the informed consent in some countries of the MENA region: A literature review. Ethics, Medicine and Public Health, 19, 100706. https://doi.org/10.1016/j.jemep.2021.100706
Haines, R. P., & Leonard, L. N. K. (2007). Situational influences on ethical decision-making in an IT context. Information & Management. https://doi.org/10.1016/J.IM.2007.02.002
Hall, I., & Hall, D. (2004). Evaluation and Ethics. https://doi.org/10.1007/978-1-349-91681-8_3
Heyler, S. G., Armenakis, A. A., Walker, A. G., & Collier, D. Y. (2016). A qualitative study investigating the ethical decision making process: A proposed model. The Leadership Quarterly, 27(5), 788–801. https://doi.org/10.1016/j.leaqua.2016.05.003
Hofstede, G. (2001). Culture’s consequences: Comparing values, behaviors, institutions and organizations across nations (2nd ed.). Sage Publications.
Jafri, S., & Margolis, L. S. (1999). The treatment of usury in the holy scriptures. Thunderbird International Business Review. https://doi.org/10.1002/TIE.4270410405
Kallio, H., Pietilä, A. M., Johnson, M., & Kangasniemi, M. (2016). Systematic methodological review: Developing a framework for a qualitative semi‐structured interview guide. Journal of Advanced Nursing, 72(12), 2954–2965. https://doi.org/10.1111/jan.13031
Larson, H. E. (2024). Moral dilemmas and limitations in global health practice. Christian Journal for Global Health. https://doi.org/10.15566/cjgh.v11i2.359
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage Publications.
Machery, E., Kelly, D., & Stich, S. (2005). Moral realism and cross-cultural normative diversity. Behavioral and Brain Sciences. https://doi.org/10.1017/S0140525X05370142
McDevitt, R., Giapponi, C., & Tromley, C. (2007). A model of ethical decision making: The integration of process and content. Journal of Business ethics, 73(2), 219-229. https://doi.org/10.1007/s10551-006-9202-6
Molterer, K., Hoyer, P., & Steyaert, C. (2020). A practical ethics of care: Tinkering with different ‘goods’ in residential nursing homes. Journal of business ethics, 165(1), 95-111. https://doi.org/10.1007/s10551-018-04099-z
Myser, C. (2003). Differences from somewhere: The normativity of whiteness in bioethics in the United States. The American Journal of Bioethics, 3(2), 1–11. DOI: https://doi.org/10.1162/152651603766436072
Oyserman, D., Coon, H. M., & Kemmelmeier, M. (2002). Rethinking individualism and collectivism: Evaluation of theoretical assumptions and meta-analyses. Psychological Bulletin, 128(1), 3–72. https://doi.org/10.1037/0033-2909.128.1.3
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533–544. https://doi.org/10.1007/s10488-013-0528-y
Rest, J. R. (1986). Moral development: Advances in research and theory. Praeger.
Rukasha, I., Essop, U. B., & Vambe, T. M. (2023). Ethics in the Shadow of Covid-19. Commonwealth Youth and Development. https://doi.org/10.25159/2663-6549/12346
Saunders, B., Sim, J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B., Burroughs, H., & Jinks, C. (2018). Saturation in qualitative research: Exploring its conceptualization and operationalization. Quality & Quantity, 52(4), 1893–1907. https://doi.org/10.1007/s11135-017-0574-8
Scotland, J. (2012). Exploring the philosophical underpinnings of research: Relating ontology and epistemology to the methodology and methods of the scientific, interpretive, and critical research paradigms. English Language Teaching, 5(9), 9–16. https://doi.org/10.5539/elt.v5n9p9
Sims, R. L., & Keon, T. L. (2000). The influence of organizational expectations on ethical decision making conflict. Journal of Business Ethics. https://doi.org/10.1023/A:1006040109517
Steinberg, D. R. (2020). Morality and Culture. https://doi.org/10.1007/978-3-030-45680-1_6
Sun, P., & Huanghe, Y. (2024). Cross-cultural differences in moral judgment, religion, and relevant factors. https://doi.org/10.1201/9781003564966-12
Tangwa, G. B. (2004). Bioethics: An African perspective. In A Companion to Bioethics (2nd ed.). Blackwell Publishing. https://doi.org/10.1111/j.1467-8519.1996.tb00118.x
Thanh, N. C., & Thanh, T. T. (2015). The interconnection between interpretivist paradigm and qualitative methods in education. American Journal of Educational Science, 1(2), 24–27. https://doi.org/10.5539/elt.v5n9p9
Vitell, S. J., Nwachukwu, S. L. S., & Barnes, J. H. (1993). The effects of culture on ethical decision-making: An application of Hofstede’s typology. Journal of Business Ethics. https://doi.org/10.1007/BF00881307
Vitell, S. J., Nwachukwu, S. L., & Barnes, J. H. (1993). The effects of culture on ethical decision-making: An application of Hofstede’s typology. Journal of Business Ethics, 12(10), 753–760. https://doi.org/10.1007/BF00881307
Vitell, S. J., Paolillo, J. G. P., & Singh, J. J. (2006). The role of money and religiosity in determining consumers’ ethical beliefs. Journal of Business Ethics, 64(2), 117–124. https://doi.org/10.1007/s10551-005-1900-0
Weaver, G. R., & Agle, B. R. (2002). Religiosity and ethical behavior in organizations: A symbolic interactionist perspective. The Academy of Management Review, 27(1), 77–97. https://doi.org/10.5465/amr.2002.5922390
Werth Jr, J. L., Blevins, D., Toussaint, K. L., & Durham, M. R. (2002). The influence of cultural diversity on end-of-life care and decisions. American Behavioral Scientist, 46(2), 204-219. https://doi.org/10.1177/000276402236673
Werth, J. L., Blevins, D., Toussaint, K. L., & Durham, M. R. (2002). The Influence of Cultural Diversity on End-of-life Care and Decisions. American Behavioral Scientist. https://doi.org/10.1177/000276402236673
Wiisak, J., Stolt, M., Igoumenidis, M., Chiappinotto, S., Gastmans, C., Keogh, B., ... & Promocon Consortium. (2024). Factors contributing to the promotion of moral competence in nursing. Nursing Ethics, 31(8), 1367-1388. https://doi.org/10.1177/09697330241235305
Wines, W. A., & Napier, N. K. (1992). Toward an understanding of cross-cultural ethics: A tentative model. Journal of Business Ethics. https://doi.org/10.1007/BF00872361
Wright, F., Cohen, S., Cohen, S., & Caroselli, C. (1997). Diverse decisions. How culture affects ethical decision making. Critical Care Nursing Clinics of North America. https://doi.org/10.1016/S0899-5885(18)30292-2
Yeager, A. L. (2015). Ethical decision making. Journal of the American Dental Association. https://doi.org/10.1016/J.ADAJ.2015.06.015
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Fourat Ben Amor, Amel Dakoumi Hamrouni, Hatem Dellagi
This work is licensed under a Creative Commons Attribution 4.0 International License.
